Thyroid

Anaplastic thyroid carcinoma

April 30, 2007     Troy Hutchins, MD; Paul Friedlander, MD; Enrique Palacios, MD, FACR
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Hypothyroidism following hemithyroidectomy for benign nontoxic thyroid disease

April 30, 2007     Kristin A. Seiberling, MD; Jose C. Dutra, MD; Sanija Bajaramovic, MD
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Parathyromatosis

January 1, 2007     Janette M. Carpenter, MSN, FNP; Peter G. Michaelson, MD; Thomas K. Lidner, MD; Michael L. Hinni, MD
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Columnar cell variant of papillary thyroid carcinoma

September 30, 2006     Chester P. Barton III, MD; Joseph A. Brennan, MD; Thomas R. Lowry, MD; Michael J. Russell, MD
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A case of papillary carcinoma arising in ectopic thyroid tissue within a branchial cyst with neck node metastasis

September 30, 2006     Rao K. Mehmood, MBBS, MD; Shaik I. Basha, MBBS, MS; Essan Ghareeb, MBBS
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Abstract
We describe the interesting case of a young man who presented with a lateral neck node that was diagnosed as a branchial cyst. Histopathology of the excised node revealed that a papillary carcinoma was located within thyroid tissue, which in turn was located within a branchial cyst. A total thyroidectomy with local lymph node clearance was performed. Histology identified a normal thyroid gland, but a papillary carcinoma in one of the excised lymph nodes was consistent with a metastasis. To our knowledge, this is only the second reported case of a thyroid carcinoma arising in ectopic thyroid tissue that metastasized in the neck.

Thyroidectomy for substernal goiter via a mediastinoscopic approach

July 31, 2006     Veling W. Tsai, MD, JD; Robert B. Cameron, MD; Marilene B. Wang, MD
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Abstract
We report an unusual case in which a patient presented with a large posterior mediastinal goiter that extended to the level of the aorta. The goiter was resected through a standard Kocher neck incision with mediastinoscopic assistance. The large goiter was completely excised without the need for a sternotomy.

Neoplasms metastatic to the thyroid gland

July 31, 2006     Lester D.R. Thompson, MD, FASCP
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Fibrin glue in thyroid and parathyroid surgery: Is under-flap suction still necessary?

July 31, 2006     Manish Patel, MD; Rohit Garg, MD; Dale H. Rice, MD
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Abstract
The introduction of fibrin sealants has brought into question the necessity of routinely placing suction drains. We conducted a retrospective study to determine whether fibrin sealants are comparable to traditional drains in terms of length of hospital stay and hematoma prevention. We evaluated 124 patients who had undergone thyroidectomy and 47 patients who had undergone parathyroidectomy. Of these, 22 thyroid surgery patients and 10 parathyroid surgery patients had their incisions closed without a drain after the application of fibrin glue. We found that the use of fibrin glue resulted in a statistically significant decrease in the length of hospital stay following both types of surgery (p = 0.033 and p = 0.022, respectively). Two hematomas in the drain group required immediate surgical evacuation; in both of these patients, the suction was clotted and ineffective. One minor hematoma occurred in the fibrin glue group, and it was opened at the bedside 24 hours after surgery. We conclude that fibrin sealants offer a comparative advantage over under-flap suction in both thyroid and parathyroid surgery. Also, fibrin glue is less expensive, and its use obviates the discomfort felt by patients when a drain is removed.

Warthin-like tumor of the thyroid gland: An uncommon variant of papillary thyroid cancer

January 1, 2006     Harold H. Kim, MD; David Myssiorek, MD; Keith S. Heller, MD; Fazlur Zahurullah, MD; Tawfiqul Bhuiya, MD
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Abstract
Several variants of papillary thyroid cancer have been described, including, most recently, Warthin-like tumor of the thyroid gland. To bring attention to this uncommon variant, we review previous reports on this entity and we add 5 new cases to the literature. We retrospectively reviewed the records of all patients who had undergone thyroidectomy at our institution during a 7-year period. Among these cases, we identified 5 patients who had had a Warthin-like tumor of the thyroid. From their charts, we compiled data on age, sex, lymphadenopathy, distant spread, and treatment. Pathologic specimens were reviewed for tumor size, capsular invasion, and vascular invasion. All 5 patients were women (mean age: 51.6 yr). Tumor size ranged from 0.9 to 2.0 cm. Multifocality was seen in 1 of the 5 patients; this patient was also the only one who experienced capsular and vascular invasion. No patient had lymph node spread or distant metastasis. Because the follow-up period among these patients was still short, we were unable to analyze long-term survival data.

Diagnostic accuracy of palpation-guided and image-guided fine-needle aspiration biopsy of the thyroid

May 31, 2005     Steven L. Goudy, MD; Michael B. Flynn, MD
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Abstract
We conducted a retrospective study to compare the sensitivity and specificity of traditional palpation-guided fine-needle aspiration biopsy (FNAB) performed by clinicians and pathologists with that of image-guided FNAB performed by radiologists for the evaluation of thyroid nodules. We reviewed the medical records of 89 patients who had undergone thyroid FNAB and subsequent surgical excision and pathology. Of this group, 58 patients had undergone palpation-guided FNAB performed by a clinician, 20 had undergone palpation-guided FNAB performed by a pathologist, and 11 had undergone image-guided FNAB performed by a radiologist. The sensitivity of the three techniques was 86, 100, and 100%, respectively, and the specificity was 78, 94, and 44%; there were no statistically significant differences in sensitivity or specificity among the three groups. Our data indicate that FNAB of the thyroid can be performed with equal reliability by clinicians, pathologists, and radiologists.

Electrophysiologic laryngeal nerve monitoring in high-risk thyroid surgery

May 31, 2005     Phillip Song, MD; Larry Shemen, MD, FRCS, FACS
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Abstract
We recently began performing intraoperative electrophysiologic monitoring of the recurrent laryngeal nerve and the external branch of the superior laryngeal nerve during high-risk thyroidectomies. Neuromonitoring can detect stimulation of these nerves and thereby prevent a mechanical or thermal injury that can result in neurapraxia or axonotmesis. Monitoring is also useful during dissection in an already operated-on field, when performing thyroidectomy on patients who depend on their voice for their livelihood, and when removing a large goiter or mediastinal mass.

Dyshormonogenetic goiter of the thyroid gland

April 1, 2005     Lester D.R. Thompson, MD
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